I was hardly able from lameness, Boils &c to give Water-cure [hydrotherapy] a fair trial this time … .29
He told Hooker on 22 January 1860 that ‘I mean to come to London on Tuesday evening for the vain purpose of consulting a new Doctor for my stomach … .’ The doctor in question, according to Darwin’s account book, was a Dr Edward Headland, ‘the leading general physician in London’.30 However, Darwin’s tone implies that he had no confidence in any cure being found.
Darwin wrote to his son William on 22 March to say that
I am trying under a Mr [Dr] Headland a course of nitro-muriatic acid [an archaic term for hydrochloric acid], eating no sweet things & drinking some wine: but it has done nothing for me as yet & I shall go to my grave, I suppose, grumbling & groaning with daily, almost hourly, discomfort.31
By 25 June he was in despair.
My stomach has utterly broken down & I am forced to go on Thursday for a little water-cure, to Dr Lanes Sudbrook Park, Richmond, Surrey [where Dr Edward Wicksted Lane had opened a new hydropathic establishment], where I shall stay a week … .32
On 23 April 1861 Darwin told Hooker,
I spoke a few minutes at [Linnean Society] on Thursday & though extra well, it brought on 24 hours vomiting.33
Darwin declared, in late August, that a recent holiday in Torquay, Devonshire with the family had resulted in ‘some benefit to my health & much good to my daughter’s [Henrietta]’.34
Darwin wrote to Hooker in mid-September 1862 from Cliff Cottage – a modest, thatched abode in Bournemouth where he was holidaying, to say:
I have been thinking of [visiting] Cambridge, for a few days, & your going [there] is an immense temptation, but I very much fear I shall not be strong enough; I have had [a] headach[e] half [of] every day, with my stomach intolerably bad.35
In January 1863 Darwin told Hugh Falconer that his eczema had ‘taken off the epidermis [outer layer of the skin] a dozen times clean off …’.36 later, on 23 March, he told Fox, ‘I am having an attack of Eczema on my face … .’ He describes ‘having had [the] first attack of this horrid & blessed eczema’ at Ilkley in Yorkshire (which he had visited in autumn 1859).37 Three days later he informed Hooker that he had ‘consulted the great Mr Startin’ for his eczema – James Startin being a leading skin specialist in London.38
On 3 November, and again in the following month, William Brinton, Physician to St Thomas’s Hospital, London and a specialist in stomach disorders, attended Darwin at Down House.39 September found him once again at Malvern Wells, this time receiving treatment from Dr Gully’s associate, physician and surgeon James Smith Ayerst.40
Wrote Darwin in late January 1864, ‘I shd suppose few human beings had vomited so often during the last 5 months.’41 And a month later, ‘The vomiting is not now daily … . My head hardly now troubles me, except singing in ears – It is now six months since I have done a stroke of work … .’42 That spring Darwin was so indisposed, health-wise, that he was obliged to dictate his letters to Emma instead of writing them himself.
In April Darwin consulted Dr William Jenner, Physician Extraordinary to Queen Victoria and Physician to University College Hospital, London who prescribed ‘small & very frequent doses of Chalk, Magnesia & Carbonate of ammonia’, but with only limited success.43 That December Darwin wrote:
I have suffered from almost incessant vomiting for nine months, & that this has so weakened my brain, that any excitement brings on whizzing & fainting feelings, when I cannot speak; & much of this makes me for days afterwards very unwell … .44
For a workaholic like Darwin to be denied the opportunity to pursue his studies, and instead to be confined to his bed or couch, or incarcerated in one or other hydropathic establishment, must have been unutterably frustrating and vexatious. And, to make matters worse, some of the finest physicians in the land could offer no convincing diagnosis, let alone a cure.
Darwin was visited at Down House on 20 May 1865 by yet another in a long line of medical experts, this time physician, author, and publisher Dr John Chapman, who, with a view to curing his persistent vomiting, recommended the application of ice (contained in a specially designed ice bag) to the spinal area.45 However, on 7 June, Darwin informed Chapman that ‘the ice does not stop either [the] flatulence or sickness …’.46
By far the most comprehensive account of his state of health was written by Darwin himself on the very day of Dr Chapman’s visit. It reads as follows:
For [the past] 25 years extreme spasmodic daily & nightly flatulence: occasional vomiting; on two occasions prolonged during months. Extreme secretion of saliva with flatulence, Vomiting preceded by shivering, hysterical crying dying sensations or half-faint. & copious very [pallid] urine. Now vomiting & every paroxys[m] of flatulence preceded by singing of ears, rocking, treading on air & vision. focus & black dots— All fatigues, specially reading, brings on these Head symptoms ?? [the question marks indicating, presumably, that Darwin did not know what was causing these symptoms] nervousness when E. [Emma] leaves me.
(What I vomit [is] intensely acid, slimy (sometimes bitter) corrodes teeth.)
Doctors puzzled, say suppressed gout [a vague and ill-defined condition] Family gouty. No organic mischief [according to Drs] Jenner & Brinton [whom he had previously consulted].
Tongue crimson in morning ulcerated— stomach constricted dragging. Feet coldish.— Pulse 58 to 62—or slower & like thread. Appetite good — not thin. Evacuation [of bowels] regular & good. Urine scanty (because do not drink) often much pinkish sediment when cold— seldom headache or nausea.
Cannot walk above ½ mile — always tired — conversation or excitement tires me most.
Heavy sleep— bad day.
Eczema—(now constant) lumbago— fundament [buttocks]— rash.
Always been temperate— now wine comforts me much— could not take any formerly. Physic no good— Chalk & Magnesia.— Water-cure & Douche. Last time at Malvern could not stand it –
I fancy that when much sickness my stomach is cold— at least water is very little warmed.
I feel nearly sure that the air is generated somewhere lower down than the stomach & as soon as it regurgitates into the stomach the discomfort comes on.
Does not throw up the food.
Instruction— How soon any effect? How long continue treatment?47
Although this account by Darwin is, at times, difficult to interpret, he describes his commonest symptoms as being flatulence, vomiting, fatigue, visual and auditory disturbances, and anxiety. However, his appetite remains good, and he has not lost weight (‘not thin’).
In July, and again in August, Darwin consulted physician and chemist Henry Bence Jones, who recommended a diet which consisted of ‘almost exclusively bread & meat’.48 On 7 September he informed the surveyor, civil engineer, and architectural draftsman Edward Cresy, who had advised him with regard to alterations to be made to Down House, ‘I have been confined to my bed-room with almost constant sickness for the last four months, and have seen nobody and done nothing.’49 On the 27th he told Hooker that Bence Jones’s diet ‘has done me good’ and that ‘my vomiting is immensely reduced’.50 However, on 25/26 October, he told Fox that Bence Jones ‘has stopped my vomiting by a scanty diet of toast & meat, yet I cannot recover my strength.’51
In early January 1866 he wrote that
I have not yet much taste for common meat, but eat a little game or fowl twice a day & eggs, omelet or macaroni or cheese at the other meals & these I think suit me best.52
In February 1868,
I am at work again, as hard as I am able. It is really a great evil, that from habit I have no pleasure in hardly anything except natural history, for nothing else makes me forget my ever recurrent uncomfortable sensations.53
A year later, in February 1869, he wrote, ‘My health continues the same; I am always what is called ‘a poor Devil’; but I am able to work for two or three hours daily.’54 and in April, ‘I am not very well owing to a fall from my horse ….’55 D
arwin was evidently still able to ride, despite his ill health.
To Hooker, on 22 June, he wrote from Barmouth in North Wales, where he was taking a prolonged holiday with the family:
I have been as yet in a very poor way: it seems as soon as the stimulus of mental work stops, my whole strength gives way: as yet I have hardly crawled half a mile from the House, & then been fearfully fatigued. It is enough to make one wish oneself quiet in a comfortable tomb.56
Darwin informed Dr Bence Jones, in early August 1870, that his stomach was ‘diabolical’.57
In late January 1871 he said, ‘I was so ill yesterday I hardly knew what I wrote’,58 while, on 15 March, he wrote to Patrick Matthew, ‘My health keeps very indifferent & every exertion fatigues me, so that I doubt whether I shall be good for much more [i.e. work]’.59 And on 6 November,
My health is very weak: I never pass 24 hours without many hours of discomfort, when I can do nothing whatever. I have thus also lost two whole consecutive months this summer.60
The evidence clearly points overwhelmingly to the fact that there was something chronically amiss with Darwin’s health. But what?
Possible causes of Darwin’s illness
1. Cyclic Vomiting Syndrome
In an article entitled ‘Darwin’s Illness Revisited’, published in December 2009, John A. Hayman, Associate Professor, Department of Anatomy and Developmental Biology, Monash University, Melbourne, Australia, stated categorically
Darwin’s symptoms are those of cyclical vomiting syndrome. Although this is primarily a disease of children it may persist into adulthood or may appear for the first time in adulthood.
People with cyclical vomiting syndrome experience abdominal, circulatory, and cerebral symptoms, including headaches and anxiety. Symptoms overlap with those of classic and abdominal migraine, except for a lack of aura [white or coloured light surrounding the object in view].
Affected people may experience some or all of these symptoms, with each individual having similar symptoms with each episode. Over time, however, progression or change may occur in the most prominent feature, and episodes may coalesce.
Episodes of illness may be divided into three phases – prodromal [the period between the appearance of initial symptoms and the full development of clinical symptoms and signs], emetic, and recovery – often with definite triggering events. Symptoms in the prodromal phase include fatigue, palpitations, and sweating. The emetic phase may consist of continuous nausea, with vomiting two to 20 times an hour. In most people this is associated with severe abdominal pain. Episodes may last one or two days or up to a week.61
There are several reasons why this theory does not fit with the facts. For example, Darwin seldom experienced headaches; abdominal pain was not a feature of his condition, and his symptoms, more often than not, lasted not ‘one or two days or up to a week’, but for weeks or even months at a time.
2. Lactose Intolerance Syndrome
The metabolism of lactose – a constituent of milk and dairy products – by the body into glucose and galactose, is dependent on the secretion of the enzyme lactase, from the mucosa of the small intestine. Many adults suffer from lactose intolerance which is the result of the lactase level declining with age.
What happens to the lactose in the intestine of a lactase-deficient person? The lactose is a good energy source for microorganisms in the colon, and they ferment it to lactic acid while also generating methane (CH4) and hydrogen gas (H2). The gas produced creates an uncomfortable feeling of gut distension and the annoying problem of flatulence.
The lactic acid produced by the microorganisms is osmotically active and draws water into the intestine, as does any undigested lactose, resulting in diarrhea [a loose, watery stool]. If severe enough, the gas and diarrhea hinder the absorption of other nutrients such as fats and proteins.62
This theory can also be discounted, again on the grounds that neither abdominal pain nor diarrhoea were features of Darwin’s condition.
3. Infection with Helicobacter pylori
Barry J. Marshall and J. Robin Warren of the University of Western Australia were awarded the Nobel Prize for Medicine for their discovery of the bacterium Helicobacter pylori and its role in the causation of gastritis and peptic ulcer disease in October 2005. Furthermore, in February 2009, Marshall proposed that Helicobacter pylori was the cause of Darwin’s chronic ill health.63
According to US Professor of Medicine Gerald L. Mandell and others,
H. pylori has been isolated from persons in all parts of the world. The high prevalence and incidence of colonization [i.e. infection of the alimentary tract] among persons in settings where sanitary conditions are suboptimal, including … developing countries, suggests that fecal-oral transmission occurs.64
In other words, the infection is probably spread as the result of poor personal hygiene.
H. pylori may cause an acute upper gastrointestinal illness with nausea and upper abdominal pain. Vomiting, burping, and fever may also be present. Symptoms last from 3 to 14 days, with most illnesses persisting less than 1 week.65
It was the case that, in both duodenal and gastric ulceration (other than those caused by irritant drugs such as aspirin), H. pylori was almost invariably present in the organs concerned.66
David A. Warrell, Emeritus Professor of Tropical Medicine at Oxford University, described in detail, how
H. pylori … increases [the] release of the acid-stimulating hormone, gastrin [produced in the duodenum and pylorus, which stimulates the production of gastric acid by the stomach]. The increase in acid secretion directly damages the duodenal mucosa [lining]. Acid hypersecretion also produces gastric metaplasia [abnormal change in the nature of a tissue67] in the proximal duodenum. This allows H. pylori to colonize the duodenum and produce duodenitis … . These changes result in duodenal ulcers.68
Duodenal ulcers typically present with pain that is dull and located in the epigastrium [upper abdomen] or to the right of it over the duodenum itself. It is characteristically relieved by eating, then gets worse when the stomach empties. The pain usually wakes the patient from sleep in the middle of the night and is relieved by eating food, drinking milk, or taking an alkali preparation (antacid). The pain is … episodic with exacerbations lasting a few weeks separated by pain-free periods. These last for several weeks or months and probably reflect spontaneous healing of the ulcer. Patients with duodenal ulcer often have other symptoms such as retrosternal burning and acid regurgitation. Nausea and vomiting are unusual and appetite is preserved.69
Colonization of the stomach itself with H. pylori may damage its mucosa in a similar way.
Patients with chronic gastric ulcers tend to be over 40 years old and from lower socioeconomic groups. Epigastric pain is the most frequent symptom. It occasionally radiates to the back if the ulcer is located posteriorly. Food or antacids usually relieve it. It typically occurs in exacerbations lasting for several weeks with symptom-free periods in between. Night pain occurs in a minority of patients with gastric ulcer compared with most of those with duodenal ulcers. Gastric ulcers quite often produce nausea, anorexia, or weight loss … . Some patients vomit, but many ulcers [i.e. ulcer sufferers] have no symptoms until the patient presents with haemorrhage … .70
Once again, in Darwin’s case, the absence of abdominal pain, and the frequency and severity of his vomiting, makes it highly unlikely that he suffered from ulcers, and therefore from Helicobacter pylori infection.
4. Crohn’s disease
This chronic inflammatory disease can affect any part of the alimentary tract, but most commonly the terminal ileum (small intestine). Its onset is usually seen in adolescence, or in those over the age of sixty. Common symptoms are spasms of pain in the abdomen, chronic sickness, loss of appetite, weight loss, and rectal bleeding.
Yet again, the presence of abdominal pain in Crohn’s disease rules this out, as far as Darwin is concerned.
NOTES
1. Darwin to John Wickham Flower, 23 March, C
or.5, p.8.
2. Darwin to Fox, 24 October, Cor.5, p.100.
3. Oxford Dictionaries Online.
4. Darwin to Fox, 17 July, Cor.5, p. 147.
5. Down House MS, reproduced in Colp, Ralph, Darwin s Illness, pp.187–257.
6. Cor.5, p.190.
7. Darwin to Hooker, 14 August, Cor.5, p.408.
8. Darwin, Francis, op. cit., pp.54–5.
9. Cor.10, p.190, pp.xxii-xxiii.
10. Colp, Darwin’s Illness, p.170.
11. Darwin to Hooker, Cor.5, p.507.
12. Darwin to Fox, 3 October, Cor.6, p.238.
13. Darwin to Lyell, 13 April, Cor.6, p.376 and p.377, note 5.
14. Darwin to Darwin, 13 May, Cor.6, pp.394–95.
15. Darwin to Hooker, 2 June, Cor.6, p.404.
16. Darwin to Hooker, 10 April, Cor.7, p.65.
17. Darwin to Lyell, 26 April, Cor.7, p.83.
18. Oxford Dictionaries Online.
19. Darwin to Emma, Cor.7, p.84.
20. Darwin to Fox, 8 May, Cor.7, p.90.
21. Darwin to Hooker, 8, Cor.7, p.102.
22. Darwin to Syms Covington, 16 January 1859, Cor.7, p.235.
23. Darwin to John Phillips, 8 February, Cor.7, pp.245–6.
24. Darwin to Fox, 12, Cor.7, p.247
25. Darwin to Hooker, 18 May 1859, Cor.7, p.299.
26. Darwin to Hooker, Cor.7, p.300.
27. Cor.7, p.343.
28. Darwin to Fox, Cor.7, p.377.
29. Darwin to Fox, 25 December, Cor.7, p.449.
30. Darwin to Hooker, 22 January 1860, Cor.8, p.45 and note 4.
31. Darwin to Fox, 22, Cor.8, p.133.
32. Darwin to Lyell, 25, Cor.8, p.265.
33. Darwin to Hooker, 23, Cor.9, pp.98–9.
34. Darwin to W.B. Tegetmeier, 29 August, Cor.9, p.242.
35. Darwin to Hooker, Cor.10, p.419.
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